3What Successful Health-Related Community 

Partnerships Have in Common 

	 

Findings	from	comprehensive	studies	of	 

health-related	community	partnerships	 

confirm	that	partnerships	play	a	significant	 

role	in	improving	public	health.1

	Although	 

every	partnership	is	unique,	research	reveals	 

that	high-performance	health-related	 

community	partnerships	appear	to	have	 

specific	strategies	and	practices	in	common,	 

while	low-performance	partnerships	are	 

deficient	in	one	or	more	of	these	same	 

strategies	and	practices.2

	These	findings	are	 

applicable	to	TB	partnerships.	 

Use a Mutual Selection Process 

when Recruiting Partners 

Nine Practices Common in HighPerformance Partnerships 

•	 Use a mutual selection process when 

recruiting partners 

•	 Encourage size and value diversity 

•	 Recruit partners who are leaders 

within stakeholder communities 

•	 Understand and address partner 

motivations 

•	 Establish ground rules (codes of 

conduct) 

•	 Embrace a common vision 

•	 Develop commitment through leadership 

•	 Create decisionmaking protocols 

•	 Anticipate and manage conflict 

Early	on,	high-performance	partnerships	employ	practices	designed	to	ensure	they	 

get	the	right	people	on	board.	This	initial	investment	of	time	and	resources	can	be	 

characterized	as	a	mutual	selection	process.3

	The	process	begins	when	respected	and	 

influential	community	leaders	and	organizations	from	key	stakeholder	groups	have	been	 

identified.	Partnership	recruiters	then	contact	these	individuals	and	organizations.	 

The	success	of	the	process	is	founded	on	establishing	trust	with	potential	partners	 

through	an	open	and	honest	exchange	of	information.	The	partnership	recruiter	 

communicates	an	interest	in,	and	respect	for,	the	health	priorities	and	concerns	of	the	 

potential	partner.	In	addition,	the	partnership	recruiter	clearly	describes	the	 

• Purpose	of	the	partnership	 

• Resources	available	to	the	partnership	to	carry	out	its	work	 

• Rights	and	obligations	of	partners 

Through	this	process,	potential	partners	understand	that	the	partnership	is	a	working	 

group	where	partners	are	expected	to	make	a	commitment	of	time,	financial,	or	physical	 

1

Shortell	SM,	Zukoski	AP,	Alexander	A,	et	al.	2002.	Evaluating	partnerships	for	community	health	improvement:	
 

Tracking	the	footprints.	Journal	of	Health	Politics,	Policy,	and	Law	1:	49–91.
 

2

Ibid.
 

	3Weiner	BJ,	Alexander	JA.	1998.	The	challenge	of	governing	public-private	community	health	partnerships.	Health	
 

Care	Management	Review	23,	no.	2:39–55.
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter : What Successful Health-Related Community Partnerships Have in Common 
 

resources.	Through	dialogue	and	information	sharing,	recruiters	and	potential	partners	 

openly	and	honestly	explore	whether	the	partnership	is	a	good	fit.	According	to	those	 

who	use	the	mutual	selection	process,	the	end	result	is	a	partnership	with	committed	 

team	players	that	“free	riders”	and	those	not	willing	to	“check	their	turf	issues	at	the	 

door”	choose	not	to	join.4	 

Additional	information	on	recruiting	is	provided	in	Chapter	5:	Determining Your Purpose 

and Choosing Partners.	 

Encourage Size and Value Diversity 

High-performance	health-related	partnership	members	represent	a	wide	range	of	 

partners,	and	such	partnerships	tend	to	have	multiple	participants	from	key	stakeholder	 

groups,	including	target	and	consumer	populations.	They	seek	out	and	obtain	political	 

support	at	state	and	local	levels,	and	use	a	variety	of	methods	to	ensure	both	input	and	 

accountability.	Thus,	the	partnership	is	seen	as	both	credible	and	relevant.5

	 

High-performance	partnerships	value	diversity.6 Cultural	competence	is	a	precursor	to	 

working	effectively	with	partners	from	diverse	cultures.	Partnership	cultural	competence	 

can	be	defined	as	a	set	of	consistent	behaviors,	attitudes,	and	policies	that	enable	diverse	 

members	to	work	effectively	in	multicultural	settings.	For	health	programs	to	achieve	 

cultural	competence,	they	must	ensure	that	consumer	populations	play	an	active	 

role	in	the	partnership’s	assessment	of	the	population’s	needs,	as	well	as	in	program	 

development,	implementation,	and	evaluation.	In	addition,	culturally	competent	 

agencies	and	staff	facilitate	ongoing	co-learning	among	care	providers	and	community	 

members.7	 

Additional	information	addressing	partnership	size	and	diversity	is	provided	in	the	 

following	chapters: 

Chapter	4.	How Well Do You Know Your Environment? 

Chapter	5.		Determining Your Purpose and Choosing Partners	 

Chapter	6. Creating a Sense of Ownership 

Chapter	7.	Making Progress and Making Decisions: Structure and Decisionmaking Issues 

Recruit Partners Who Are Leaders within Stakeholder Populations 

High-performance	partnership	recruiters	understand	the	difference	between	being	a	key	 

community	leader	and	being	the	representative	of	a	respected	community-based	or		 

4

Ibid.
 

5

Shortell	et	al.	
 

6

Ibid.	
 

7

Health	Resources	Services	Administration.	2001.	Cultural competence works.	
 

0 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter : What Successful Health-Related Community Partnerships Have in Common 
sector-based	service	organization.	High-performance	partnerships	addressing	community	 

health	have	both	key	community	leaders	as	partners	and	supporters,	as	well	as	 

representatives	of	community-based	service	organizations	as	partners.	 

The	key	leaders	recruited	by	high-performance	partnerships	are	respected	by	their	 

communities	or	population	sectors,	have	credibility	and	visibility,	are	well	integrated	 

into	their	communities,	and	have	substantial	influence	in	them.8

	Research	suggests	that	 

partnerships	are	more	productive	when	they	recruit	respected	leaders	who	understand	 

the	different	perspectives	that	exist	within	their	community	or	population	sector,	and	 

who	use	this	understanding	to	ensure	the	partnership	acts	in	ways	that	minimize,	rather	 

than	exacerbate,	these	differences.9 

High-performance	partnerships	use	recruiting	sessions	to	learn	from	and	gain	the	 

support	of	respected	and	influential	community	leaders.	In	these	sessions,	recruiters:	 

•	 Elicit	and	value	the	health	priorities	and	perspectives	of	community	leaders	 

•	 Provide	epidemiological	data	and	anecdotes	that	show	the	leaders	why	their	 

participation	is	vital	to	the	success	of	the	partnership	 

•	 Discuss	how	the	partnership	will	benefit	the	leaders’	communities	 

Additional	information	on	leadership	issues	is	provided	in	Chapter	4:	How Well Do 

You Know Your Environment? and	Chapter	5:	Determining Your Purpose and Choosing 

Partners. 

Understand and Address the Motivational Issues of Potential 

Partners 

Leaders	of	high-performance	partnerships	recognize	that	dual	attention	must	be	given	to	 

building,	nurturing,	and	maintaining	the	partnership,	and	to	engaging	in	task-oriented	 

behaviors	that	realize	the	partnership’s	goals	and	objectives.

10	Leaders	employ	a	variety	of	 

ongoing	strategies	to	build	trust,	while	motivating	partners	to	increase	their	commitment	 

to	and	alignment	with	partnership	interests	over	time.	They	recognize	that	partners,	 

whether	viewed	as	organizations	or	as	individuals,	have	a	variety	of	motivations,	and	they	 

effectively	address	these	motivations.11	Motivations	can	be	categorized	into	three	broad	 

areas:	 

•	 A	desire	to	help	others	(altruism) 

•	 A	desire	to	be	instrumental	in	increasing	the	individual’s	or	organization’s	ability	to	 

achieve	their	goals 

	8Israel,	BA,	Schultz	AJ,	Parker	EA,	et	al.	1998.	Review	of	community-based	research:	Assessing	partnership	
 

approaches	to	improve	public	health. Annual Review of Public Health 19:176-202,	187
 	9Weiner	and	Alexander,	17.
 

10Shortell	et	al.,	6.
 

11Ibid.
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter : What Successful Health-Related Community Partnerships Have in Common 
•	 A	desire	to	increase	the	individual	or	organization’s	legitimacy	or	credibility12	 

Understanding	and	nurturing	motivations	associated	with	altruism	and	legitimacy	are	 

essential	to	sustaining	a	long-term	commitment	from	partners.13 

Establish Ground Rules (Codes of Conduct) 

High-performance	partnerships	operate	in	ways	that	promote	understanding	while	 

demonstrating	sensitivity	and	competence	in	working	with	diverse	cultures.	The	 

partnerships	consistently	operate	in	ways	that	promote	listening,	openness,	caring,	 

inclusiveness,	agreement	to	disagree,	an	opportunity	for	all	to	participate,	and	mutual	 

respect.14	The	process	for	establishing	these	ground	rules,	including	how	the	partnership	 

makes	decisions,	must	be	consistent	with	the	rules	themselves.	These	ground	rules	or	 

codes	of	conduct	are	most	effective	when	developed	by	the	members.	The	extent	to	 

which	these	rules	are	formal	or	informal	arrangements	is	best	decided	by	each	individual	 

partnership.	The	level	of	formality	by	which	these	rules	are	established	does	not	influence	 

partnership	productivity.15	 

Additional	information	on	establishing	ground	rules	is	available	in	Chapter	6: Creating a 

Sense of Ownership.	 

Embrace a Common Vision 

An	initial	investment	of	time	and	resources	by	prospective	partners	is	usually	required	 

to	establish	the	trust	that	leads	to	a	common	vision	and	shared	commitment	to	 

that	vision.16	Extensive	sharing	of	information	aimed	at	creating	a	common	and	 

comprehensive	understanding	of	the	external	and	internal	environment	helps	to	 

build	trust	and	is	a	precursor	to	forming	a	common	vision	and	creating	strong	group	 

commitment	to	it.17	Early	in	their	development,	high-performance,	multisector,	healthrelated	partnerships	successfully	work	together	to	create	a	shared	vision	that	incorporates	 

all	four	of	the	following	guiding	principles: 

•	 A	focus	on	community	health,	not	just	the	health	or	treatment	of	individual	patients; 

•	 Implementation	mechanisms	that	facilitate	and	coordinate	service	delivery	to	 

the	most	appropriate	recipients,	at	the	most	appropriate	times,	and	in	the	most	 

appropriate	settings; 

12Shortell	et	al.,	6.
 

13Ibid.,	7.
 

14Israel	et	al.,	185.
 

15Jack	M,	Phillips	R.	1993.	Public-private	partnerships	in	health	care:	Cooperative	strategies	and	models.	
 

Hospitals and Health Services Administration 38,	no.	3:186.
 16Ibid.
 

17Ibid.,	7.
 

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Chapter : What Successful Health-Related Community Partnerships Have in Common 
•	 Effective	use	of	limited	resources	by	providing	the	most	efficient	services	possible;	 

and	 

•	 Active	involvement	of	multiple	and	diverse	stakeholders	in	the	identification,	 

prioritization,	and	implementation	of	partnership	goals,	objectives,	and	activities.18 

Minimizing	the	importance	of	any	one	of	these	four	guiding	principles	significantly	 

diminishes	partnership	performance.19	Partnerships	without	a	shared	vision	find	it	 

very	difficult	to	manage	member	input	or	effectively	focus	members	toward	collective	 

actions.20	Additional	information	about	creating	a	common	vision	is	provided	in	 

Chapter	6: Creating a Sense of Ownership. 

Once	a	common	vision	is	established,	high-performance	partnership	leaders	incorporate	 

the	partnership’s	vision	and	values	into	the	mutual	selection	recruiting	processes.	 

Potential	partners	and	new	recruits	are	provided	information	and	orientation	sessions	 

that	help	them	to	understand	how	the	vision	and	values	have	shaped	the	partnership’s	 

history,	culture,	activities,	composition,	and	structure,	including	communication	and	 

decisionmaking	channels	and	practices.21	 

Develop Commitment through Leadership 

Three	aspects	of	leadership	differentiate	the	multisector	health-related	partnerships	 

making	the	most	progress	from	those	making	the	least:	committed	core	leadership,	an	 

organizational	driver,	and	leadership	delegation.22		 

Committed Core Leadership 

High-performance	partnerships	tend	to	have	a	dedicated	and	respected	long-term	 

leader	who	fulfills	the	role	of	executive	director.	In	addition,	these	partnerships	tend	 

to	develop	a	committed	core	leadership	that	helps	to	create	and	consistently	reinforce	 

the	group’s	vision,	guiding	principles,	and	operating	norms,	as	well	as	meaningful	 

objectives,	tasks,	projects,	and	programs.	 

Core	leaders	help	to	create	an	accurate	and	shared	sense	of	where	the	partnership	is,	 

as	well	as	the	skills,	abilities,	resources,	and	commitments	that	are	needed	to	realize	 

the	group’s	vision	and	goals.23	Effective	core	leadership	ensures	the	partnership	uses	 

ongoing	reflective	processes	to	monitor	significant	environmental	changes	and	trends,	 

and	that	it	expands	or	repositions	assets,	competencies,	and	resources	to	effectively	 

18Shortell	et	al.,	3.;	Israel	et	al.,	186.
 

19Ibid.
 

20Ibid.,	14.
 

21Weiner	and	Alexander,	6.
 

22Shortell	et	al.,	15.
 

23Israel	et	al.,	163;	Shortell	et	al.,	16,	21–22.
 

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Chapter : What Successful Health-Related Community Partnerships Have in Common 
 

address	these	changes.	Core	leaders	do	so	without	losing	commitment	and	focus	 

on	the	partnership’s	vision	and	purpose.	They	successfully	lead	the	partnership	 

in	the	acquisition	of	new	funds,	the	blending	of	existing	resources	to	better	meet	 

partnership	priorities,	the	improving	of	initiatives	through	corrective	or	adaptive	 

actions,	and	the	effective	use	of	resources.24	 

Organizational Driver 

High-performance	partnerships	tend	to	have	a	respected	lead	or	facilitating	 

organization,	called	an	organizational	driver.	The	organizational	driver	enhances	 

partnership	stability	over	time	by	providing	staff	support	and	by	covering	operational	 

expenses.	The	organizational	driver	provides	this	support	while	maintaining	a	low	 

profile,	which	allows	the	partnership	to	establish	and	develop	a	sense	of	collective	 

identity	and	influence.25	 

Leadership Delegation 

High-performance	partnerships	are	adept	at	recognizing	when	and	where	different	 

members	need	to	take	the	lead	on	different	issues,	and	when	new	leaders	and	 

members	need	to	be	recruited	to	supplement	the	skills	and	abilities	of	the	existing	 

partners.	These	partnerships	delegate	to	those	members	closest	to	a	given	problem	 

the	authority	and	resources	to	deal	with	the	problem.26	High-performance	 

partnerships	also	serve	as	“incubators”	for	ideas,	which	are	then	spun	off	to	specific	 

members	for	implementation.	27 

Additional	information	addressing	leadership	issues	is	provided	in	the	following	chapters:	 

Chapter	4.		 How Well Do You Know Your Environment? 

Chapter	5.		 Determining Your Purpose and Choosing Partners	 

Chapter	6. Creating a Sense of Ownership 

Chapter	7.		 Making Progress and Making Decisions: Structure and Decisionmaking Issues 

Chapter	8.		 Sustaining Longer-Term Partnerships 

Create Decisionmaking Protocols 

High-performance	partnerships	recognize	there	is	no	one	best	way	to	make	decisions.	 

They	realize	that	each	partnership	is	unique	and	must	develop	the	decisionmaking	 

practices	that	best	meet	its	needs.	These	practices	are	likely	to	include	formal,	informal,	 

consensual,	and	majority	vote	processes.	In	addition,	high-performance	partnerships	 

24Shortell	et	al.,	23.	 

25Ibid.,	15. 

26Ibid.,	15-18. 

27Ibid.,	23.	 

4 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter : What Successful Health-Related Community Partnerships Have in Common 
evaluate	and	take	into	consideration	possible	unintended	consequences	of	their	actions	 

when	making	decisions.	The	key	to	successful	decisionmaking	is	to	create	and	use	 

processes	that	are	perceived	by	all	as	fair	and	open.28	Additional	information	on	how	 

to	create	effective	structure	protocols	is	provided	in	Chapter	7:	Making Decisions and 

Making Progress: Structure and Decisionmaking Issues. 

Multisector	health-related	partnerships	tend	to	be	voluntary.	As	such,	they	lack	formal	 

authority	and	administrative	power	over	members.	High-performance	partnerships	 

consistently	use	four	strategies	to	exert	influence.29 

Social Control 

In	high-performance	partnerships,	partners	believe	that	failure	to	fulfill	partnership	 

agreements	will	result	in	a	loss	of	reputation	and	social	status.30	Through	extensive	 

community	involvement,	high-performance	partnerships	are	able	to	develop	a	shared	 

sense	of	responsibility	for	partnership	outcomes	among	stakeholders,	as	well	as	 

accountability	to	the	communities	they	seek	to	serve.	Influence	is	achieved	through	an	 

“outside-in”	approach	to	planning	and	decisionmaking	that	incorporates	community	 

input	on	needs,	problems,	and	priorities.31 

Project Selection 

High-performance	partnerships	initially	develop	trust	and	cooperation	among	 

members	by	intentionally	identifying	and	choosing	projects	in	which	all	partners	have	 

an	interest,	but	that	none	has	as	a	core	service.32	These	projects	often	include	issues	 

associated	with	service	gaps	that	all	members	are	experiencing.	Buy-in	to	these	choices	 

depends	on	the	extent	to	which	members	participate	in	priority	setting	and	resource	 

allocation	decisions	associated	with	them.33	High-performance	partnerships	use	these	 

initial	projects	to	build	a	working	context	within	which	members	build	the	trusting	 

and	respectful	relationships	that	will	allow	them	to	address	and	successfully	manage	 

issues	in	which	there	is	less	initial	agreement.34	 

Credible Commitment 

High-performance	partnerships	require	members	to	make	commitments	of	time,	inkind,	or	financial	resources	that	result	in	mutually	beneficial	relationships	that	lead	to	 

interdependencies	among	partners.35	 

28Weiner	et	al.,	21. 

29Weiner	et	al.,	6. 

30Ibid.,	7. 

31Ibid.,	11. 

32Ibid.,	6. 

33Ibid.,	11. 

34Ibid.,	18–20. 

35Ibid.,	7.	 

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Chapter : What Successful Health-Related Community Partnerships Have in Common 
 

Building Ownership 

High-performance	partnerships	employ	three	interrelated	strategies	that	contribute	 

to	increased	commitment	by	members	and	stakeholders	to	partnership	goals	and	 

objectives.36	These	strategies	are 

•	 Working	in	and	through	existing	stakeholder	structures,	both	formal	and	
 

informal,	in	the	populations	and	sectors	the	partnership	seeks	to	impact.	
 

•	 Creating	multiple	opportunities	for	stakeholders	and	partners	to	exchange	
 

information.	These	opportunities	may	be	formal	or	informal.	
 

•	 Creating	a	sense	of	community	ownership	by	having	members	share	responsibility	 

for	planning	and	facilitating	meetings.	 

Additional	information	on	strategies	and	practices	that	help	to	increase	partners’	 

commitment	and	productivity	are	provided	in	the	following	chapters:	 

Chapter	4.		 How Well Do You Know Your Environment? 

Chapter	5.		 Determining Your Purpose and Choosing Partners	 

Chapter	6. Creating a Sense of Ownership 

Chapter	7.		 Making Progress and Making Decisions: Structure and Decisionmaking Issues 

Chapter	8.		 Sustaining Longer-Term Partnerships 

Anticipate and Manage Conflict 

High-performance	partnerships	recognize	that	conflict	is	a	natural	part	of	partnering	 

with	diverse	groups,	and	are	able	to	anticipate	and	use	conflict	constructively.37	They	 

recognize	that	relying	heavily	on	conflict-avoidance	behaviors	is	not	effective.	Highperformance	partnerships	employ	the	following	strategies	to	minimize	the	negative	 

aspects	of	conflict:	38		 

•	 Create	a	sense	of	interdependency	among	partnership	members.	 

•	 Create	a	sense	among	partners	of	being	well	informed	by	regularly	providing	updated	 

information	to	them. 

•	 Work	continuously	to	maintain	a	high	degree	of	trust	among	partners.39	 

•	 Create	a	process	of	decisionmaking	that	is	perceived	by	all	as	fair	and	open.	 

When	interpersonal	trust	is	lacking	among	members,	research	reveals	that	partnerships	 

tend	to	rely	on	accommodation	to	resolve	conflict,	a	conflict-resolution	style	that	is	likely	 

to	attain	short-term	harmony	at	the	expense	of	longer-term	goals	and	objectives.40 

36Ibid.,	15-16.
 

37Shortell	et	al.,	20.
 

38Ibid.
 

39Ibid.
 

40Ibid.
 

 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter : What Successful Health-Related Community Partnerships Have in Common 
Additional	information	on	managing	differences	is	provided	in	Chapter	6:	Creating a 

Sense of Ownership	and	Chapter	7: Making Progress and Making Decisions: Structure and 

Decisionmaking Issues.	 

Conclusion 

High-performance,	multisector,	health-related	partnerships	value	the	relationships	that	 

members	have	with	each	other	and	that	the	partnership	and	its	members	have	with	the	 

stakeholders	and	communities	they	seek	to	serve.	These	partnerships	employ	strategies	 

that	allow	them	to	recruit	and	retain	diverse,	talented,	and	influential	members	who	are	 

willing	to	create	a	shared	vision	of	improved	health	and	to	undertake	the	tasks	required	 

to	make	that	vision	a	reality.		 

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Chapter : What Successful Health-Related Community Partnerships Have in Common